Our View - Friday

Reed it and weep

Neglect of wounded warriors can’t be tolerated

The second scandal is that it took a hard-hitting expose in the federal government’s hometown newspaper to bring what might actually be some effective attention to the deplorable conditions faced by wounded military personnel at Walter Reed Army Medical Center. The first scandals are the conditions that exist there.

As the Washington Post revealed in a follow-up story, the attention paid to Walter Reed sparked a torrent of e-mails and phone calls from wounded warriors and veterans who have tried for years to call attention to equally deplorable conditions at military and Veterans Administration hospitals all over the country.

Soldiers and their families, faced with unsanitary conditions, bureaucratic runarounds, deteriorating facilities and a lack of decent equipment, have been writing for years to members of Congress, to generals and Defense Department officials, seeking improvements — or even the courtesy of attention. Until a confluence of events occurred — a well-documented expose, a Democratic Congress eager to pillory a Republican president, an ABC newsman who had been grievously wounded in Iraq and did a TV special on his experience in the system, a new defense secretary — nothing much happened.

Because appointing a task force or blue-ribbon panel is Washington's knee-jerk response to every problem, President Bush appointed a commission headed by former Sen. Robert Dole and former HHS Secretary Donna Shalala to look into the care of wounded warriors and veterans. But the best bet is that after a flurry of attention and some improvements, and after a few more heads roll, the system will lapse into neglect.

It became obvious early in the Iraq war that, thanks to the skills of battlefield surgeons, large numbers of soldiers who in previous wars would have died in the field were being saved. But one consequence of this welcome development is that many of them require medical attention for years or for the rest of their lives.

There is little disagreement that most of the doctors and nurses in military hospitals are highly skilled, highly motivated, and dedicated to the welfare of their patients. Mixed in with complaints about rats, roaches and peeling paint are stories of remarkable feats of medical skill and unfailing compassion on the part of medical personnel.

So how, if everyone agrees that our military personnel deserve the best medical care available, and most of those who staff them work so hard and so well, did they come to such a sorry pass?

The short answer is that these are government institutions that face the perverse incentives every government institution faces. With no effective competition and without the discipline of a profit-and-loss mechanism that could lead to inefficient institutions being forced to shut down, the tendency, despite the efforts of many within the system, is to lapse into mediocrity and worse.

At Walter Reed, VIPs sometimes received treatment in the main facilities, but they never saw Building 18, where the most deplorable conditions prevailed. As is so often the case with government institutions, simple maintenance, which is not obvious to the public until it is neglected for years, tended to be deferred.

As Donald Boudreaux, chairman of the economics department at George Mason University said, “When you’re working with other people’s money there is no incentive to allocate resources wisely. There’s no personal feedback mechanism, no way to set priorities intelligently, no entrepreneurial fire in the belly to figure out how to do things in the most efficient, effective way possible, because there’s no direct reward for such innovative thinking.” Indeed, questioning the old ways is more likely to be punished than rewarded.

The usual substitute in government for the discipline of the marketplace is oversight by higher-ups, but too often this simply translates into new layers of bureaucracy that demand endless reports and paperwork but no genuine accountability. This frustrates the best-intentioned professionals and workers, who all too often resign themselves to the fact that “the system” will never change and they’ll just have to endure.

Some are pointing to “privatization” efforts at the hospital as one culprit. That is nonsense. A few services at Walter Reed are contracted out, but there’s no effort to change the basic character of the government-military institution. It is that character that largely explains the long-term problems and widespread conditions that have come to light.

The remarkable thing is that despite the repeatedly documented shortcomings of military and veterans’ hospitals, which are the closest thing to fully socialized medicine we have in this country, a significant sector of the public believes that more socialized health care would be appropriate in what is now the semiprivate sector.

Case closed

Robert Novak, whose July 2003 column launched the Valerie Plame affair, which concluded with a multiple convictions for former White House aide Lewis “Scooter” Libby, might be a good person to consult on the meaning of it all. In a column this week, focusing on how crestfallen Democrats are because it never panned out as a second Iran-Contra scandal, Novak pointed out that “the Libby trial uncovered no plot hatched in the White House.” The jury never heard from the man who actually leaked Plame’s identity to Novak. The leak itself wasn’t a crime. And special prosecutor Patrick Fitzgerald never even established that Plame was an undercover agent.

“George W. Bush lost control of this issue when he permitted a special prosecutor to make decisions that . . . turned out to be inherently political,” Novak writes. “It would have taken courage for the president to have aborted this process. It would require even more courage for him to pardon Scooter Libby now, not while he is walking out of the White House in January 2009.”